Limited English proficiency (LEP) has been indicated as one of the major barriers to receiving adequate healthcare in American medical settings. As such it constitutes a special need of a particular at-risk and underserved population. This is a serious health disparity issue in that 21 million Americans identified themselves as LEP at the 2000 census. LEP patients are less likely to seek medical care and to comply with medical regimen when they do seek medical care. Also LEP patients are less likely to understand what medical personnel say during the medical consultation and to understand instructions that medical personnel give regarding prescribed regimen. Consultations with LEP patients require more time and resources than do consultations with English proficient patients, and the use of interpreters and bilingual providers does not guarantee access to adequate healthcare for LEP patients. The goal of this work -- consistent with the Mission of the National Institute for Nursing Research -- is to identify communication practices in the medical setting that contribute to better healthcare outcomes for LEP patients and thereby improve the clinical settings in which care is provided. These will be measured by degree of understanding during the consultation. The specific hypothesis behind the proposed research is that medical personnel, whether bilingual or not, who are adept at interactionally accommodating to LEP patients will produce better consultation outcomes for LEP patients. That hypothesis is based on the following observation as reflected in previous research and in preliminary data analysis. First, different medical facilities have different institutional cultures that affect the forms of talk within the institution. Second, within one institution, there are likely different means of communicating with LEP patients, whether through bilingual medical staff, bilingual family members, interpreters, or through interactionally accommodating to LEP patients. Specific Aim # 1: Identify the means of communicating with LEP patients that providers use. Specific Aim #2: Assess the degree to which different means of communicating with LEP patients result in beneficial communicative outcomes. PUBLIC HEALTH RELEVANCE: Applied Linguistics and Limited English Proficiency in the Medical Setting (C. Vickers) This proposed project will assist the National Institute of Nursing Research in improving the clinical settings in which care is provided, emphasizing the special needs of at-risk and under-served populations;by seeking to identify communication strategies for Limited English Proficient patients and their professional caregivers. The work will aid in health promotion, disease prevention, self- management in health and illness;as well as directly address health disparities of LEP groups.